Organization
LIFE SPECIALTY PHARMACY, INC
Active
Other names
Life Specialty Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL AYOTUNDE (PHARMACIST)
(407) 522-5683
Entity
Organization
Contact information
Practice address
1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL 32835-5795
(407) 522-5683
(407) 522-5684
Mailing address
1507 PARK CENTER DR, SUITE 1L, ORLANDO, FL 32835-5795
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH23699
FL
3336H0001X
Home Infusion Therapy Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1042009
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/04/2009
Last updated
04/29/2009
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